Distance Learning Services - Library Card Application

This application is for students who are ONLY enrolled in Distance Learning courses and cannot visit a campus library.

(* = required field in form below)

Please provide the following information:

First name:Middle name:Last name:CCRI ID number:CCRI barcode:Your CCRI barcode number is the 14-digit number just below the barcode strip on your CCRI ID card. Skip this field if you do not have a CCRI ID card.Email address (CCRI email preferred):Alternate email address:Phone number:Home address:Street:City:State:Zip:Mailing address (if different from home address):Street:City:State:Zip:Distance Learning course(s) enrolled in:Note: Students under age 18 must have a perent or guardian sign this form.Age:
Under 18 years of age
18 years of age or olderI agree ...
to abide by the library's rules and regulations and to be responsible for material charged out to me. I understand that failure to return materials borrowed may result in a $100 fee per item, the loss of library privileges and the withholding of grades, transcripts, diplomas, and/or registration.Please type your name to act as your signature:If under 18 years of age:Parent/guardian signature:Parent/guardian email address:Comments:

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This page developed and maintained by Community College of Rhode Island. 400 East Avenue, Warwick, Rhode Island 02886-1807 - Telephone: (401) 825-1000. Send comments and suggestions about this site to webservices@ccri.edu.